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Biomedical subjects

A Valente

Publications and source records attributed to A Valente.

At least 37 records · Page 2Linked to original sources
PubMed1996

Nonalcoholic steatohepatitis. Clinicopathological comparison with alcoholic hepatitis in ambulatory and hospitalized patients.

This study reports a clinicopathological analysis of 105 patients whose liver histology showed a pattern of alcohol-like steatohepatitis. There were 32 nonalcoholic, 21 asymptomatic ambulatory, and 52 hospitalized alcoholic hepatitis patients. Female sex, obesity, and diabetes predominated in nonalcoholics. Clinical and laboratory presentation were similar in nonalcoholics and ambulatory alcoholics, but different from the hospitalized alcoholics. Histology showed an increasing degree of severity of hepatocellular damage, Mallory bodies, neutrophil and mononuclear infiltration, and pericellular and portal fibrosis from the nonalcoholics to the hospitalized alcoholics, with ambulatory alcoholics displaying an intermediate degree of severity. Steatosis and glycogenated nuclei were prevalent in the obese, diabetic nonalcoholics, of whom 47% had significant fibrosis and 8% cirrhosis, the latter present in 38% and 89% of ambulatory and hospitalized alcoholic hepatitis (P = 0.0001), respectively. In asymptomatic subjects with suspected liver disease, a liver biopsy is the only way of establishing the type and severity of liver lesions.

Adolescent↗
PubMed1995

Tamoxifen-associated steatohepatitis--report of three cases.

The authors describe three cases of tamoxifen-associated steatohepatitis, which resulted from a daily dosage of 20 mg used as the adjuvant treatment of breast carcinoma. Liver tests became normal after discontinuation of tamoxifen.

Adenocarcinoma↗
PubMed1995

["Occult" carcinoma of the thyroid: clinical, morphological, and biologic characteristics for a correct therapeutic regime].

The "occult" carcinoma of the thyroid is still a highly controversial topic. The controversies not only regard its diagnosis, treatment, natural history and, therefore, its biological potential, but also aspects of a nosological nature in that there is still no unequivocal acceptance of its originality, thus leading to discussions focused on its precise definition. On the basis of our experience and other published data, we have reached the following conclusions: a) the term "occult" carcinoma of the thyroid must be used to describe a neoplasia which does not exceed 1.5 cm in diameter, irrespective of the presence or otherwise of laterocervical adenopathy, and leaving aside the fact that it can be identified using clinical and instrumental tests; b) high-resolution echography and echo-guided FNA are fundamental instruments for a correct and early preoperative diagnosis; c) the clinical, morphological and, above all, biological (a very slowly evolving neoplasia) characteristics make the occult carcinoma of the thyroid seem to be a tumour with its own nosological identity; d) on the strength of the latter, and in particular in view of its natural history, conservative surgery (lobectomy with isthmectomy), in the differentiated forms, might play a primary role in the treatment of occult carcinoma of the thyroid in the very near future. However, at present complete thyroidectomy represents the treatment of choice even in differentiated forms, whereas lobectomy is only reserved for incidental cases of occult carcinoma discovered during the final histological test; e) lymphadenectomy is indicated in the event of lymph node involvement, not to achieve a longer survival rate but to reduce the incidence of recidivation in the form of lymph node metastases. In these cases, even the mere removal of macroscopically damaged lymph nodes is sufficient to ensure the virtual absence of recidivation on which, it is worth noting, metabolic radio-iodotherapy is efficacious in the large majority of cases.

Adult↗
PubMed1993

Long-term follow-up of patients initially diagnosed with syndrome X.

The clinical course of 30 patients (27 women and 3 men) diagnosed with syndrome X (angina pectoris, positive exercise test and normal coronary arteries) was evaluated during 5-year follow up. Patients were divided at the control examination into 2 groups according to the median value of the heart rate/blood pressure product variation from rest to the first stage of a modified Bruce protocol, as follows: group 1 < or = 1,050 (n = 15) and group 2 > 1,050 mm Hg x beats/min (n = 15). All patients were followed at 6-month intervals during a mean follow-up of 60 +/- 8 months. During follow-up, chest pain was unchanged in 20 patients, decreased in severity and frequency in 9 (7 in group 1, and 2 in group 2), and disappeared in 1 in group 2; 3 patients in group 1 had prolonged episodes of anginal chest pain (> 30 minutes) that needed hospitalization. In group 2, 7 patients developed systemic hypertension, 4 had a progression of exercise-induced left bundle branch block to constant left bundle branch block, and 4 continued to develop rate-dependent block during exercise, but at a reduced heart rate. In the latter 8 patients, left ventricular ejection fraction at rest during follow-up decreased significantly from 61 +/- 6% to 51 +/- 8% (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Unstable angina: role of silent ischemia and total ischemic time (silent plus painful ischemia), a 6-year follow-up.

To assess the long-term prognostic significance of total ischemic time (silent plus painful ischemia) and silent ischemia in patients with unstable angina whose condition stabilized with medical treatment, 76 patients were studied. All patients underwent Holter ambulatory electrocardiographic (ECG) monitoring for greater than or equal to 48 h beginning within the 1st 12 h of the hospital stay. Forty-three patients (Group A) had a total ischemic time greater than or equal to 60 min, whereas 33 patients (Group B) had a total ischemic time less than 60 min. More than 78% of the ischemic episodes in patients in Group A and 62% of those in Group B were silent (p less than 0.05); nine patients in Group A and six in Group B had only silent episodes. Patients in Group A frequently showed three-vessel disease (65% vs. 18%, p less than 0.01), angiographic findings of subtotal occlusion of the coronary arteries (TIMI grade I) (76.7% vs. 42.4%, p less than 0.01) and ischemic alterations in the rest ECG (51.2% vs. 30.3%, p less than 0.05). During a 6-year follow-up period, 15 patients in Group A and 8 in Group B experienced myocardial infarction (p less than 0.05); 9 patients in Group A and 4 in Group B required coronary artery surgery (p less than 0.05) and 10 patients in Group A and 4 in Group B died of cardiac causes (p less than 0.01). Multivariate analysis showed three-vessel disease to be the most important predictor of cardiac mortality and morbidity (p = 0.025); it was followed in predictive power by a total ischemic time greater than or equal to 60 min and by left ventricular dysfunction. The presence of silent ischemia was not shown to be an independent predictor of long-term morbidity and mortality. In conclusion, patients with unstable angina and a total ischemic time greater than or equal to 60 min frequently have silent ischemic episodes on Holter ECG monitoring, a greater extent of coronary atherosclerosis and ischemic alterations of the rest ECG. The long-term prognosis of patients with unstable angina whose condition stabilizes with medical treatment depends on the extent of coronary atherosclerosis and on the longer duration of total ischemic time but not on the presence of silent ischemia.

Actuarial Analysis↗
PubMed1992

Characterization and long-term prognosis of patients with effort-induced silent myocardial ischaemia.

The aim of this study was to evaluate the anatomo-clinical correlations and the prognostic significance of silent myocardial ischaemia (SI) during exercise testing (ET). Four hundred and six patients with angiographically proven CAD and positive ET were studied. Patients were divided into two groups: 309 patients (Group A) with positive ET for both electrocardiographical findings and angina, and 97 patients (Group B) with positive ET for electrocardiographical findings but not for angina (SI). In Group A the following clinical characteristics differed significantly from Group B: incidence of diabetes mellitus (15.8% vs 27.8%, P less than 0.04); duration of disease (less than 1 month from its first manifestation) (30.4% vs 54.6%, P less than 0.001) and a positive ET at low work-load (41.7% vs 50.5%, P less than 0.05). Mortality during follow-up (mean 72 +/- 11 months) was 8.6% in Group A and 8.2% in Group B (NS). Incidence of sudden death was similar in the two groups (2.9% vs 2.06%; NS). The multivariate analysis shown as independent variables, related significantly with a poor prognosis in both groups: left ventricular function (P less than 0.0001); prior myocardial infarction (P less than 0.0001); and multivessel disease (P less than 0.001). In conclusion, patients with a recent onset of symptoms, a positive ET at low workload and diabetes mellitus are more likely to present SI during ET. The long-term prognosis and the incidence of sudden death are similar in patients with painful and painless myocardial ischaemia during ET.

Angina Pectoris↗
PubMed1990

Acute effects of nifedipine versus isosorbide dinitrate on exercise tolerance in patients with isolated coronary artery occlusion and collaterals.

The acute effects of slow-release nifedipine and isosorbide dinitrate on exercise tolerance were compared in nine patients with isolated total coronary artery occlusion showing retrograde filling via collaterals. All patients had a reproducible positive exercise stress test off medication before the study. Each patient was randomized to 10 mg slow-release nifedipine and 5 mg isosorbide dinitrate in a single-blind, cross-over study. The exercise stress test was performed 30 minutes after drug administration. After nifedipine, three patients had a negative exercise stress test, whereas the test was negative after isosorbide dinitrate only in one patient. A significantly higher exercise tolerance was detected at peak exercise after nifedipine than after isosorbide dinitrate, as shown by a longer exercise time (380 +/- 44 vs. 295 +/- 41 seconds, p less than 0.001), a more increased maximum work load (355 +/- 89 vs. 255 +/- 55 W x min, p less than 0.02), and a higher rate-pressure product (30,300 +/- 2,500 vs. 26,100 +/- 2,700, p less than 0.01). In conclusion, these results seem to suggest that nifedipine may have a vasomotor effect on collaterals, since it elevated the threshold of ischemia more than isosorbide dinitrate did in patients with isolated coronary artery occlusion, showing retrograde filling via collaterals.

Angina Pectoris↗
PubMed1989

Neurovegetative assessment in subjects with a risk for hypertension.

Cardiacneurovegatative assessment was studied in 60 subjects divided into three groups consisting of 20 normotensive subjects without familial hypertension, 20 normotensive subjects with familial hypertension, and 20 patients with mild hypertension. Cardiacneurovegetative function was investigated by evaluations of these parameters: systolic, diastolic, and mean blood pressure, heart rate, skin temperature, skin conductance, and muscular contraction. These measurements were taken before and after psychological stress (mathematical, Sacks' incomplete sentences, electrical, auditory) and after physical stress (cold, hand grip, head-up tilt, lying, and standing). The results showed a significant difference of the psychophysiologic profiles among the three groups. On the contrary, the cardiovascular variables were not very sensitive or well-discriminating, especially when response amplitude was considered. In conclusion we propose the hypothesis that identification of the psychophysiologic profile in certain individuals may be a better marker for future development of hypertension in subjects with a genetic risk.

Adult↗
PubMed1989

[Effects of slow-release isosorbide-5-mononitrate on ergometric parameters and cardiac output in stable effort angina pectoris: a double-blind randomized placebo study].

The effects of a single oral dose of 60 mg of sustained release (R) isosorbide-5-mononitrate (ISM) administered in 9 male patients (mean age: 53 +/- 7 years) with stable exercise-induced angina pectoris were studied in a randomized, double blind, cross-over study. The effectiveness of the drug was evaluated by concomitant ergometer exercise stress test and cardiac output determination (bioimpedance method, Bomed Med-Ltd) performed 1 hour before and 1, 4, 10 and 24 hours after acute administration of placebo (P) and ISM-R. After P, all patients showed a positive exercise test, whereas 3 patients during ISM-R treatment had a negative exercise stress test 1 and 4 hours after ISM-R administration. Compared with P, ISM-R produced a statistically significant improvement of exercise stress test parameters at peak exercise (maximum work load, heart rate, systolic and diastolic blood pressures and double product) up to 10 hours after drug administration. On the other hand, cardiac output did not significantly differ at any time after ISM-R compared with both control conditions and P treatment. Moreover, no side effect was detected in any patient during the study. In conclusion, a single oral dose of 60 mg of sustained-release ISM-R seems to be an effective drug in the treatment of effort angina, its effectiveness lasting more than 10 hours without side effects.

Adult↗
PubMed1988

Neonatal tonsillar teratoma.

A newborn boy with a giant tonsillar teratoma or epignathus is described along with details of his management. This is a rare lesion and few survivors have been reported.

Humans↗